Shingles

Introduction

Shingles - also known as herpes zoster - is a skin disease caused by the so-called varicella-zoster virus. Shingles therefore has the same cause as the highly contagious chickenpox ("wild chickenpox"). Only someone who has had chickenpox at some point in their life can develop shingles: once the chickenpox has healed, the virus remains in the body and continues to lie dormant in certain nerve nodes. The virus can subsequently be reactivated - usually decades later - in the form of shingles. In most cases, people contract shingles after the age of 45.

The disease is characterised by a general feeling of illness, pain, reddening of the skin and blisters, which are often limited to a strip of skin similar to shingles. In contrast to chickenpox, shingles is not very contagious. There is a vaccination that can prevent it to a certain extent. If shingles occurs despite the vaccination, it is more harmless than in unvaccinated people.

Symptoms

At the beginning of shingles, there is a general feeling of illness, those affected are tired and have a slight fever. The typical symptoms of shingles follow a few days later: the varicella-zoster viruses trigger a skin rash after reactivation. The skin in the affected area swells to a reddish colour and nodules form - these are usually arranged in groups. The nodules turn into blisters containing a watery or bloody fluid.

Unlike chickenpox, only a localised part of the body is affected by a rash in the case of shingles. The rash only appears on one side of the body. In most cases, shingles develops on the chest or abdomen, but occasionally the symptoms of the disease appear on the face, ear or neck.

Course

As a rule, shingles is harmless and heals without consequential damage. Even without treatment, shingles usually disappears within two to four weeks. However, the skin rash typical of shingles leaves its mark even in mild cases of the disease: the affected areas of skin are often more tanned or the skin loses its colour. Shingles is extremely rare in children. However, if it does occur, it is usually uncomplicated - in adults, on the other hand, severe pain can occur.

Complications can occur during the course of the disease. In the case of herpes zoster on the face, the eye can also be affected (with serious consequences such as detachment of the retina) or permanent paralysis of the face can occur. Other secondary diseases of shingles can be zoster encephalitis (brain), zoster meningitis (meninges), zoster myelitis (spinal cord) or pneumonitis (pneumonia), which can lead to a serious medical condition. If shingles spreads to the whole body and internal organs (zoster disseminatus), it can also lead to a life-threatening condition that requires hospital treatment. Such severe courses of the disease mainly affect people who are immunocompromised or whose immune system is suppressed by medication (immunosuppressants). Patients over the age of 65 have an increased risk of cardiovascular diseases such as myocardial infarction or stroke in the first year after shingles.

In some cases, there is damage to several nerves - in these cases, specialists refer to this as polyneuropathy. The occurrence of Guillain-Barré syndrome is also possible. In this case, the muscles are weakened: the muscle weakness can lead to paralysis of the arms and legs. In very rare cases, the diaphragm is also affected. Breathing then stops and the patient has to be ventilated.

In 10 to 15 per cent of cases, the nerve pain caused by shingles lasts for months to years (post-zoster neuralgia).
In contrast to chickenpox, shingles during pregnancy does not pose a risk of congenital malformations.

Causes

Shingles can only develop in someone who has had chickenpox at some point in their life. Once the chickenpox has healed, the so-called varicella zoster virus remains in the body and continues to lie dormant in certain nerve nodes. The virus can subsequently be reactivated - usually decades later - in the form of shingles. Such reactivation of the virus usually occurs due to stress or a weakened immune system.

People who have been vaccinated against varicella can also contract herpes zoster - in these cases it is a milder form of shingles. Unlike chickenpox, shingles is only contagious via the contents of the blisters. However, the contents of the blisters are only infectious to people who have never had chickenpox. However, such an initial infection with varicella does not cause shingles: people infected in this way develop chickenpox.

Diagnosis

Shingles is diagnosed based on the typical symptoms - burning pain and localised blisters in certain areas of the body. Only in rare cases is it necessary to detect the actual pathogen, the varicella-zoster virus. This is the case if there are no clear symptoms of shingles. As shingles often occurs in people with a weakened immune system, those affected should also be examined for other illnesses during the diagnosis.
As a general rule, a doctor should be consulted at the first sign of shingles. In this way, treatment will have an optimal effect and the symptoms will disappear more quickly.

Treatment

In the case of shingles, the symptoms, specifically the pain and reddening of the skin, are treated. As a rule, doctors prescribe medication that specifically targets the herpes viruses. Medication is also used to alleviate the pain. In addition, those affected can support the healing process by resting and carefully caring for the inflamed skin.

Prevention

For some years now, the Federal Office of Public Health FOPH has recommended vaccination against shingles with the Zostavax vaccine. The FOPH is in favour of vaccination for people between the ages of 65 and 79. Patients aged between 50 and 79 who are expected to develop immunodeficiency in the near future (e.g. due to planned immunosuppressive therapy) should also be vaccinated.